|
QUETIAPINE 100MG/ML TOPICAL GEL CUSTOM
|
Facility
|
IP
|
$21.55
|
|
|
Service Code
|
NDC 09900000367
|
| Hospital Charge Code |
161484
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$19.39 |
| Rate for Payer: Aetna American Axle |
$14.01
|
| Rate for Payer: Aetna Commercial |
$18.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.01
|
| Rate for Payer: Cash Price |
$17.24
|
| Rate for Payer: Cofinity Commercial |
$15.09
|
| Rate for Payer: Cofinity Commercial |
$18.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.24
|
| Rate for Payer: Healthscope Commercial |
$19.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.32
|
| Rate for Payer: PHP Commercial |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.01
|
| Rate for Payer: Priority Health SBD |
$13.58
|
| Rate for Payer: UMR Bronson Commercial |
$9.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.16
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
NDC 67877025001
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.04 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna American Axle |
$91.65
|
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.65
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health SBD |
$88.83
|
| Rate for Payer: UMR Bronson Commercial |
$62.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
OP
|
$2.02
|
|
|
Service Code
|
NDC 60687034911
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna American Axle |
$1.31
|
| Rate for Payer: Aetna Commercial |
$1.72
|
| Rate for Payer: Aetna Medicare |
$1.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.31
|
| Rate for Payer: BCBS Complete |
$0.81
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cofinity Commercial |
$1.41
|
| Rate for Payer: Cofinity Commercial |
$1.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.62
|
| Rate for Payer: Healthscope Commercial |
$1.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.72
|
| Rate for Payer: PHP Commercial |
$1.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.31
|
| Rate for Payer: Priority Health SBD |
$1.27
|
| Rate for Payer: UMR Bronson Commercial |
$0.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.51
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
NDC 67877025001
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna American Axle |
$91.65
|
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna Medicare |
$70.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.65
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health SBD |
$88.83
|
| Rate for Payer: UMR Bronson Commercial |
$52.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$451.20
|
|
|
Service Code
|
NDC 00904664061
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.53 |
| Max. Negotiated Rate |
$406.08 |
| Rate for Payer: Aetna American Axle |
$293.28
|
| Rate for Payer: Aetna Commercial |
$383.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.28
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Commercial |
$315.84
|
| Rate for Payer: Cofinity Commercial |
$388.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$315.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Healthscope Commercial |
$406.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.52
|
| Rate for Payer: PHP Commercial |
$383.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.28
|
| Rate for Payer: Priority Health SBD |
$284.26
|
| Rate for Payer: UMR Bronson Commercial |
$198.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.40
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
OP
|
$451.20
|
|
|
Service Code
|
NDC 00904664061
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.94 |
| Max. Negotiated Rate |
$406.08 |
| Rate for Payer: Aetna American Axle |
$293.28
|
| Rate for Payer: Aetna Commercial |
$383.52
|
| Rate for Payer: Aetna Medicare |
$225.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.28
|
| Rate for Payer: BCBS Complete |
$180.48
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Commercial |
$315.84
|
| Rate for Payer: Cofinity Commercial |
$388.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$315.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Healthscope Commercial |
$406.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.52
|
| Rate for Payer: PHP Commercial |
$383.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.28
|
| Rate for Payer: Priority Health SBD |
$284.26
|
| Rate for Payer: UMR Bronson Commercial |
$166.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.40
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
OP
|
$201.40
|
|
|
Service Code
|
NDC 60687034901
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.52 |
| Max. Negotiated Rate |
$181.26 |
| Rate for Payer: Aetna American Axle |
$130.91
|
| Rate for Payer: Aetna Commercial |
$171.19
|
| Rate for Payer: Aetna Medicare |
$100.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.91
|
| Rate for Payer: BCBS Complete |
$80.56
|
| Rate for Payer: Cash Price |
$161.12
|
| Rate for Payer: Cofinity Commercial |
$140.98
|
| Rate for Payer: Cofinity Commercial |
$173.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.12
|
| Rate for Payer: Healthscope Commercial |
$181.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.19
|
| Rate for Payer: PHP Commercial |
$171.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.91
|
| Rate for Payer: Priority Health SBD |
$126.88
|
| Rate for Payer: UMR Bronson Commercial |
$74.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.05
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$201.40
|
|
|
Service Code
|
NDC 60687034901
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.62 |
| Max. Negotiated Rate |
$181.26 |
| Rate for Payer: Aetna American Axle |
$130.91
|
| Rate for Payer: Aetna Commercial |
$171.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.91
|
| Rate for Payer: Cash Price |
$161.12
|
| Rate for Payer: Cofinity Commercial |
$140.98
|
| Rate for Payer: Cofinity Commercial |
$173.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.12
|
| Rate for Payer: Healthscope Commercial |
$181.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.19
|
| Rate for Payer: PHP Commercial |
$171.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.91
|
| Rate for Payer: Priority Health SBD |
$126.88
|
| Rate for Payer: UMR Bronson Commercial |
$88.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.05
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$2.02
|
|
|
Service Code
|
NDC 60687034911
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna American Axle |
$1.31
|
| Rate for Payer: Aetna Commercial |
$1.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.31
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cofinity Commercial |
$1.41
|
| Rate for Payer: Cofinity Commercial |
$1.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.62
|
| Rate for Payer: Healthscope Commercial |
$1.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.72
|
| Rate for Payer: PHP Commercial |
$1.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.31
|
| Rate for Payer: Priority Health SBD |
$1.27
|
| Rate for Payer: UMR Bronson Commercial |
$0.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.51
|
|
|
QUETIAPINE 200 MG TABLET
|
Facility
|
IP
|
$424.32
|
|
|
Service Code
|
NDC 63739067710
|
| Hospital Charge Code |
21825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.70 |
| Max. Negotiated Rate |
$381.89 |
| Rate for Payer: Aetna American Axle |
$275.81
|
| Rate for Payer: Aetna Commercial |
$360.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.81
|
| Rate for Payer: Cash Price |
$339.46
|
| Rate for Payer: Cofinity Commercial |
$297.02
|
| Rate for Payer: Cofinity Commercial |
$364.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.46
|
| Rate for Payer: Healthscope Commercial |
$381.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.67
|
| Rate for Payer: PHP Commercial |
$360.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.81
|
| Rate for Payer: Priority Health SBD |
$267.32
|
| Rate for Payer: UMR Bronson Commercial |
$186.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.24
|
|
|
QUETIAPINE 200 MG TABLET
|
Facility
|
OP
|
$364.25
|
|
|
Service Code
|
NDC 16571072001
|
| Hospital Charge Code |
21825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.77 |
| Max. Negotiated Rate |
$327.82 |
| Rate for Payer: Aetna American Axle |
$236.76
|
| Rate for Payer: Aetna Commercial |
$309.61
|
| Rate for Payer: Aetna Medicare |
$182.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.76
|
| Rate for Payer: BCBS Complete |
$145.70
|
| Rate for Payer: Cash Price |
$291.40
|
| Rate for Payer: Cofinity Commercial |
$254.97
|
| Rate for Payer: Cofinity Commercial |
$313.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$254.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.40
|
| Rate for Payer: Healthscope Commercial |
$327.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.61
|
| Rate for Payer: PHP Commercial |
$309.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.76
|
| Rate for Payer: Priority Health SBD |
$229.48
|
| Rate for Payer: UMR Bronson Commercial |
$134.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.19
|
|
|
QUETIAPINE 200 MG TABLET
|
Facility
|
IP
|
$303.05
|
|
|
Service Code
|
NDC 00904664161
|
| Hospital Charge Code |
21825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.34 |
| Max. Negotiated Rate |
$272.75 |
| Rate for Payer: Aetna American Axle |
$196.98
|
| Rate for Payer: Aetna Commercial |
$257.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.98
|
| Rate for Payer: Cash Price |
$242.44
|
| Rate for Payer: Cofinity Commercial |
$212.13
|
| Rate for Payer: Cofinity Commercial |
$260.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.44
|
| Rate for Payer: Healthscope Commercial |
$272.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.59
|
| Rate for Payer: PHP Commercial |
$257.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.98
|
| Rate for Payer: Priority Health SBD |
$190.92
|
| Rate for Payer: UMR Bronson Commercial |
$133.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.29
|
|
|
QUETIAPINE 200 MG TABLET
|
Facility
|
OP
|
$424.32
|
|
|
Service Code
|
NDC 63739067710
|
| Hospital Charge Code |
21825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$381.89 |
| Rate for Payer: Aetna American Axle |
$275.81
|
| Rate for Payer: Aetna Commercial |
$360.67
|
| Rate for Payer: Aetna Medicare |
$212.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.81
|
| Rate for Payer: BCBS Complete |
$169.73
|
| Rate for Payer: Cash Price |
$339.46
|
| Rate for Payer: Cofinity Commercial |
$297.02
|
| Rate for Payer: Cofinity Commercial |
$364.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.46
|
| Rate for Payer: Healthscope Commercial |
$381.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.67
|
| Rate for Payer: PHP Commercial |
$360.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.81
|
| Rate for Payer: Priority Health SBD |
$267.32
|
| Rate for Payer: UMR Bronson Commercial |
$157.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.24
|
|
|
QUETIAPINE 200 MG TABLET
|
Facility
|
IP
|
$364.25
|
|
|
Service Code
|
NDC 16571072001
|
| Hospital Charge Code |
21825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.27 |
| Max. Negotiated Rate |
$327.82 |
| Rate for Payer: Aetna American Axle |
$236.76
|
| Rate for Payer: Aetna Commercial |
$309.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.76
|
| Rate for Payer: Cash Price |
$291.40
|
| Rate for Payer: Cofinity Commercial |
$254.97
|
| Rate for Payer: Cofinity Commercial |
$313.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$254.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.40
|
| Rate for Payer: Healthscope Commercial |
$327.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.61
|
| Rate for Payer: PHP Commercial |
$309.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.76
|
| Rate for Payer: Priority Health SBD |
$229.48
|
| Rate for Payer: UMR Bronson Commercial |
$160.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.19
|
|
|
QUETIAPINE 200 MG TABLET
|
Facility
|
OP
|
$303.05
|
|
|
Service Code
|
NDC 00904664161
|
| Hospital Charge Code |
21825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.13 |
| Max. Negotiated Rate |
$272.75 |
| Rate for Payer: Aetna American Axle |
$196.98
|
| Rate for Payer: Aetna Commercial |
$257.59
|
| Rate for Payer: Aetna Medicare |
$151.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.98
|
| Rate for Payer: BCBS Complete |
$121.22
|
| Rate for Payer: Cash Price |
$242.44
|
| Rate for Payer: Cofinity Commercial |
$212.13
|
| Rate for Payer: Cofinity Commercial |
$260.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.44
|
| Rate for Payer: Healthscope Commercial |
$272.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.59
|
| Rate for Payer: PHP Commercial |
$257.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.98
|
| Rate for Payer: Priority Health SBD |
$190.92
|
| Rate for Payer: UMR Bronson Commercial |
$112.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.29
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
IP
|
$399.50
|
|
|
Service Code
|
NDC 67877024238
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.78 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Aetna American Axle |
$259.68
|
| Rate for Payer: Aetna Commercial |
$339.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.68
|
| Rate for Payer: Cash Price |
$319.60
|
| Rate for Payer: Cofinity Commercial |
$279.65
|
| Rate for Payer: Cofinity Commercial |
$343.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$279.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.60
|
| Rate for Payer: Healthscope Commercial |
$359.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$279.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.57
|
| Rate for Payer: PHP Commercial |
$339.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.68
|
| Rate for Payer: Priority Health SBD |
$251.69
|
| Rate for Payer: UMR Bronson Commercial |
$175.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.62
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
IP
|
$406.55
|
|
|
Service Code
|
NDC 47335090288
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.88 |
| Max. Negotiated Rate |
$365.89 |
| Rate for Payer: Aetna American Axle |
$264.26
|
| Rate for Payer: Aetna Commercial |
$345.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.26
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cofinity Commercial |
$284.58
|
| Rate for Payer: Cofinity Commercial |
$349.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$284.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.24
|
| Rate for Payer: Healthscope Commercial |
$365.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$284.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.57
|
| Rate for Payer: PHP Commercial |
$345.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.26
|
| Rate for Payer: Priority Health SBD |
$256.13
|
| Rate for Payer: UMR Bronson Commercial |
$178.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.91
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
OP
|
$406.55
|
|
|
Service Code
|
NDC 47335090288
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.42 |
| Max. Negotiated Rate |
$365.89 |
| Rate for Payer: Aetna American Axle |
$264.26
|
| Rate for Payer: Aetna Commercial |
$345.57
|
| Rate for Payer: Aetna Medicare |
$203.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.26
|
| Rate for Payer: BCBS Complete |
$162.62
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cofinity Commercial |
$284.58
|
| Rate for Payer: Cofinity Commercial |
$349.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$284.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.24
|
| Rate for Payer: Healthscope Commercial |
$365.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$284.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.57
|
| Rate for Payer: PHP Commercial |
$345.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.26
|
| Rate for Payer: Priority Health SBD |
$256.13
|
| Rate for Payer: UMR Bronson Commercial |
$150.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.91
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
OP
|
$361.90
|
|
|
Service Code
|
NDC 00904663861
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna American Axle |
$235.24
|
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna Medicare |
$180.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.24
|
| Rate for Payer: BCBS Complete |
$144.76
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$253.33
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$253.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.24
|
| Rate for Payer: Priority Health SBD |
$228.00
|
| Rate for Payer: UMR Bronson Commercial |
$133.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.43
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
IP
|
$361.90
|
|
|
Service Code
|
NDC 00904663861
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.24 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna American Axle |
$235.24
|
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.24
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$253.33
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$253.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.24
|
| Rate for Payer: Priority Health SBD |
$228.00
|
| Rate for Payer: UMR Bronson Commercial |
$159.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.43
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
OP
|
$399.50
|
|
|
Service Code
|
NDC 67877024238
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.81 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Aetna American Axle |
$259.68
|
| Rate for Payer: Aetna Commercial |
$339.57
|
| Rate for Payer: Aetna Medicare |
$199.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.68
|
| Rate for Payer: BCBS Complete |
$159.80
|
| Rate for Payer: Cash Price |
$319.60
|
| Rate for Payer: Cofinity Commercial |
$279.65
|
| Rate for Payer: Cofinity Commercial |
$343.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$279.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.60
|
| Rate for Payer: Healthscope Commercial |
$359.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$279.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.57
|
| Rate for Payer: PHP Commercial |
$339.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.68
|
| Rate for Payer: Priority Health SBD |
$251.69
|
| Rate for Payer: UMR Bronson Commercial |
$147.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.62
|
|
|
QUETIAPINE 400 MG TABLET
|
Facility
|
IP
|
$463.68
|
|
|
Service Code
|
NDC 00904664361
|
| Hospital Charge Code |
70398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.02 |
| Max. Negotiated Rate |
$417.31 |
| Rate for Payer: Aetna American Axle |
$301.39
|
| Rate for Payer: Aetna Commercial |
$394.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.39
|
| Rate for Payer: Cash Price |
$370.94
|
| Rate for Payer: Cofinity Commercial |
$324.58
|
| Rate for Payer: Cofinity Commercial |
$398.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.94
|
| Rate for Payer: Healthscope Commercial |
$417.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.13
|
| Rate for Payer: PHP Commercial |
$394.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.39
|
| Rate for Payer: Priority Health SBD |
$292.12
|
| Rate for Payer: UMR Bronson Commercial |
$204.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.76
|
|
|
QUETIAPINE 400 MG TABLET
|
Facility
|
OP
|
$510.24
|
|
|
Service Code
|
NDC 60687038201
|
| Hospital Charge Code |
70398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.79 |
| Max. Negotiated Rate |
$459.22 |
| Rate for Payer: Aetna American Axle |
$331.66
|
| Rate for Payer: Aetna Commercial |
$433.70
|
| Rate for Payer: Aetna Medicare |
$255.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.66
|
| Rate for Payer: BCBS Complete |
$204.10
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cofinity Commercial |
$357.17
|
| Rate for Payer: Cofinity Commercial |
$438.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.19
|
| Rate for Payer: Healthscope Commercial |
$459.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.70
|
| Rate for Payer: PHP Commercial |
$433.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.66
|
| Rate for Payer: Priority Health SBD |
$321.45
|
| Rate for Payer: UMR Bronson Commercial |
$188.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.68
|
|
|
QUETIAPINE 400 MG TABLET
|
Facility
|
IP
|
$5.11
|
|
|
Service Code
|
NDC 60687038211
|
| Hospital Charge Code |
70398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna American Axle |
$3.32
|
| Rate for Payer: Aetna Commercial |
$4.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.32
|
| Rate for Payer: Cash Price |
$4.09
|
| Rate for Payer: Cofinity Commercial |
$3.58
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.09
|
| Rate for Payer: Healthscope Commercial |
$4.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.34
|
| Rate for Payer: PHP Commercial |
$4.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health SBD |
$3.22
|
| Rate for Payer: UMR Bronson Commercial |
$2.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.83
|
|
|
QUETIAPINE 400 MG TABLET
|
Facility
|
OP
|
$5.11
|
|
|
Service Code
|
NDC 60687038211
|
| Hospital Charge Code |
70398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna American Axle |
$3.32
|
| Rate for Payer: Aetna Commercial |
$4.34
|
| Rate for Payer: Aetna Medicare |
$2.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.32
|
| Rate for Payer: BCBS Complete |
$2.04
|
| Rate for Payer: Cash Price |
$4.09
|
| Rate for Payer: Cofinity Commercial |
$3.58
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.09
|
| Rate for Payer: Healthscope Commercial |
$4.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.34
|
| Rate for Payer: PHP Commercial |
$4.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health SBD |
$3.22
|
| Rate for Payer: UMR Bronson Commercial |
$1.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.83
|
|
